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. 2021 Jan;41(1):150-157.
doi: 10.1111/liv.14671.

Impact of metabolic risk factors on the severity and outcome of patients with alcohol-associated acute-on-chronic liver failure

Ajay Duseja  1 , Arka De  1 , Sunil Taneja  1 , Ashok Kumar Choudhury  2 , Harshad Devarbhavi  3 , Jinhua Hu  4 , Saeed S Hamid  5 , Amna Subhan Butt  5 , Syed Muhammad Wasim Jafri  5 , Hasmik Ghazinian  6 , Yogesh K Chawla  1 , Radha K Dhiman  1 , Zhongping Duan  7 , Yu Chen  7 , Soek Siam Tan  8 , Guan Huei Lee  9 , Seng Gee Lim  10 , Dong Joon Kim  11 , Manoj Sahu  12 , Jose D Sollano  13 , Gian Carpio  14 , Virukalpatti Gopalratnam Mohan Prasad  15 , Zaigham Abbas  16 , Laurentius A Lesmana  17 , Cosmas Rinaldi Lesmana  17 , Chundamannil E Eapen  18 , Ashish Goel  18 , Ajit Sood  19 , Vandana Midha  19 , Omesh Goyal  19 , Abdul Kadir Dokmeci  20 , Qin Ning  21 , Tao Chen  21 , Ke Ma  21 , Diana A Payawal  22 , George K K Lau  23 , Mamun Al Mahtab  24 , Salimur Rahman  25 , Mohd Shahinul Alam  25 , Akash Shukla  24 , Ananta Shrestha  26 , Samir Shah  27 , Chetan Ramesh Kalal  27 , Guresh Kumar  28 , Priyanka Jain  28 , Irene Paulson  2 , Shiv Kumar Sarin  2 ; APASL ACLF Working Party, APASL ACLF Research Consortium (AARC)
Affiliations

Impact of metabolic risk factors on the severity and outcome of patients with alcohol-associated acute-on-chronic liver failure

Ajay Duseja et al. Liver Int. 2021 Jan.

Abstract

Background: Metabolic risk factors may impact the severity and outcome of alcoholic liver disease. The present study evaluated this effect in patients with alcohol-associated acute-on-chronic liver failure (ACLF).

Methodology: One thousand two hundred and sixteen prospectively enrolled patients with ACLF (males 98%, mean age 42.5 ± 9.4 years, mean CTP, MELD and AARC scores of 12 ± 1.4, 29.7 ± 7 and 9.8 ± 2 respectively) from the Asian Pacific Association for the Study of the Liver (APASL) ACLF Research Consortium (AARC) database were analysed retrospectively. Patients with or without metabolic risk factors were compared for severity (CTP, MELD, AARC scores) and day 30 and 90 mortality. Information on overweight/obesity, type 2 diabetes mellitus (T2DM), hypertension and dyslipidaemia were available in 1028 (85%), 1019 (84%), 1017 (84%) and 965 (79%) patients respectively.

Results: Overall, 392 (32%) patients died at day 30 and 528 (43%) at day 90. Overweight/obesity, T2DM, hypertension and dyslipidaemia were present in 154 (15%), 142 (14%), 66 (7%) and 141 (15%) patients, respectively, with no risk factors in 809 (67%) patients. Patients with overweight/obesity had higher MELD scores (30.6 ± 7.1 vs 29.2 ± 6.9, P = .007) and those with dyslipidaemia had higher AARC scores (10.4 ± 1.2 vs 9.8 ± 2, P = .014). Overweight/obesity was associated with increased day 30 mortality (HR 1.54, 95% CI 1.06-2.24, P = .023). None of other metabolic risk factors, alone or in combination, had any impact on disease severity or mortality. On multivariate analysis, overweight or obesity was significantly associated with 30-day mortality (aHR 1.91, 95% CI 1.41-2.59, P < .001), independent of age, CTP, MELD and AARC scores.

Conclusion: Overweight/obesity and dyslipidaemia increase the severity of alcohol-associated ACLF, and the former also increases the short-term mortality in these patients.

Keywords: NAFLD; NASH; alcoholic hepatitis; liver failure; metabolic syndrome; non-alcoholic fatty liver disease; obesity.

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